Making sure collarbone is completely healed key to Rodgers' return

Green Bay - The toughest medical decision the Green Bay Packers are going to have to make this season is when to allow quarterback Aaron Rodgers to return to the field.

Rodgers said today that he suffered a fractured left collarbone, and while he didn't specify whether it was a complete break, a hairline fracture or a crack, the consensus among a pair of shoulder specialists is that even if it is just a hairline fracture, it is imperative it be completely healed or he will be at risk for a much worse fracture.

"The risk is that he could take what is a non-displaced fracture, have someone throw him down and have a displaced fracture," said Chris P. O'Grady, orthopedic surgeon for the Andrews Institute for Orthopaedics & Sports Medicine, "That’s something that’s a big problem and might have to be addressed surgically.

"But the risk-benefit ratio for Aaron Rodgers is different than it would be for you or I."

In other words, there will still be risk when Rodgers returns, but it will have been managed to a point where the odds are very much in his favor.

The physiology of broken bones hasn't changed and it still takes four to eight weeks for a bone to heal. Not knowing the degree of fracture, neither specialist could comment on Rodgers' specific situation and spoke only in generalities about the injury.

"I thnk that the best-case scenario, in most cases, is four to six weeks, that’s assuming there’s an actual crack in the bone and you’re not seeing edema in the bone," said Nikhil Verma, an associate professor of orthopedics at Rush University Medical Center. "If it's a legitimate crack in the bone, it’s four to six weeks. I know the initial reports were three weeks, but (in general) that would seem aggressive."

Bur Verma also said it was probably a good sign that the medical staff needed to do more tests on Monday to determine the full extent of the injury. If it had shown up clearly on the X-rays they would have been dealing with a more significant fracture.

Coach Mike McCarthy said Tuesday that the doctors were not as optimistic Monday night as they were Tuesday when they saw more imaging of the injury.

"I’m relieved, no doubt," McCarthy said. "You talk to the doctors after the game, talk to Aaron after talking to the doctors, felt better talking to Aaron than I did talking to our medical staff. With the new information that was given today, everybody felt better about it.

"How long? We don’t have our hands around a timeline yet, but I know Aaron is very optimistic and he’ll do everything he can to get back in a timely fashion."

Both specialists see the injury being treated cautiously because Rodgers will be at risk for getting slammed on his shoulder, which is what caused the injury to happen last night. Even though it's his non-throwing shoulder, if he reinjured it he probably would be out for the season.

There is no way to protect the shoulder from the force of a 300-pound lineman driving your shoulder into the ground. That is why everything must be healed completely.

"There are two issues that you’re dealing with in my mind: one is when does the pain become at such a level that he can play," Verma said. "That may happen in three weeks, especially if it's a hairline fracture on a non-dominant arm. So first, is the ability to play based on pain and mobility and function.

"The second is what is the risk he refractures it. So, there’s a real chance that if they let him go back early and it wasn’t completely healed and he took another hit and landed on his shoulder, then he could break it and this time displace it and have a more significant break. There’s a fine line there."

Packers team physician Patrick McKenzie is met with that fine line with just about every injured player he treats. He has to make sure that the injury is completely healed and he is comfortable with putting the player back on the field.

McKenzie has been described as conservative in his approach and so the evidence will probably have to be clear for him to green light the team's franchise player. It's pretty certain he'll be back this season and the Packers don't want to lose him again while in the middle of a playoff race.

What's more, they're not going to endanger the long-term future of their organization by putting Rodgers at risk.

The telling sign both doctors said will be when McKenzie can push down on the fracture without Rodgers feeling any pain. With hairline fractures, X-rays don't do a good job of showing healing and sometimes time becomes the measuring device.

"Mainly it will be based on his exam, which would mean he’d have full range of motion and no tenderness," O'Grady said, which will robbbly happen pretty quickly."A lot of this is going to be the physiology of bone healing. Even with a professional athlete you just can’t speed that process."

About Tom Silverstein

Tom Silverstein has covered the Green Bay Packers since 1989. He is a two-time Wisconsin Sportswriter of the Year award winner.